How to do an elimination diet

In a previous post, I described how Juliana tested positive for various food intolerances, and that we had begun a test by eliminating every food to which she had a measured reaction.

But something was bothering me.  What if she was intolerant of something to which she hadn’t had a measured reaction?  In particular, to dairy?  Dairy is one of the “sensitive seven,” also including wheat, sugar, peanuts, soy, eggs and corn.  Furthermore, Jonny Bowden writes, you might want to expand the milk category to include cheese, and the wheat category to include all grains. Living Low Carb, p. 340.  And what if she was reactive to something else not on the sensitive seven list, like tomatoes, or citrus?

There are two distinct reasons why a substance might not have shown a reaction in the test.  First, she is reactive, but the test didn’t pick it up; and second, she is reactive but the testing was done incorrectly at the lab.  The opposite is also true:  she may not be reactive but a test could show that she is for either reason.  I was afraid that by only cutting out the foods to which the blood tests showed a reaction, we could still be missing something important. But I wasn’t sure how to proceed.

In a fascinating new book, with the terribly undescriptive title “Six Secrets of Successful Weight Loss,” Dr. John Mansfield, a physician from Britain, details the problems he encountered with various types of testing for food reactions in 30 years of clinical practice treating people for food intolerances.  He regards blood testing as next to useless.  His method, instead, puts people on a restricted eating plan that includes only about 40 foods for seven days.  Only foods with a very low likelihood of causing a reaction, in his clinical experience, are on the list.  After seven days, foods are tested, one by one, to see if they provoke a reaction.

There are two types of possible reactions.  One, a host of possible physical and mental symptoms:  migraine, stomachache, digestive issues, skin rashes, fatigue, low energy, depression, etc.  All the various symptoms that can be the result of food intolerances that are often thought to be psychosomatic because no clear causal pattern seems to exist to explain them.  Two, weight gain.  Sudden weight gain, such as 4 or 5 pounds over the course of a day or overnight.  Very interestingly, Dr. Mansfield treats weight gain itself as a food intolerance reaction.  He has found that the only symptom many people have of food intolerance is weight gain, and that when the offending food or foods are eliminated, normal weight is restored.

Since she eliminated grains and fruit, Juliana hasn’t had fatigue and low energy.  Her only remaining “symptom” was stalled weight loss.  Dr. Mansfield offers a protocol to investigate that symptom.  Interestingly, the approximately 40 foods that are allowed in stage 1 of the elimination diet include fruits like peaches, pears, and plums, and starchy items like sweet potatoes and turnips.  Juliana and I decided to try it.

She stuck it out for a week.  It wasn’t as hard for her as you might imagine, since she got to eat all sorts of things she has been avoiding for months, including fruit and starchy tubers.  Those were big treats.  At the end of a week, if you haven’t lost a significant amount of weight (5+ pounds), Dr. Mansfield would conclude that you don’t have food intolerance and you should  abandon the elimination diet.  So what happened?  Juliana gained 6 pounds.  (As an aside, there is no way that she ate an excess of 21,000 calories in one week.  Do we really need more evidence that weight is not a function of calories in, calories out?)

What does this tell us? Well, it certainly tells us, again, that she is very sensitive to carbohydrate.  The fruit and starchy tubers she ate sent her weight right back up. To get the most information, however, we cut out all the fruits and starchy carbs so she hopefully wouldn’t gain any more weight, and then we added back each food she had been avoiding, one by one, and watched for a reaction.

The first was broccoli, then lemon, pork, garlic, cauliflower, beef.  Juliana weighs herself on waking in the morning, and before eating dinner.  We test one new food or drink in the morning, and one in the evening.  A significant weight gain overnight or during the day–more than the normal variation we observed prior to starting the plan–is a reaction, and indicates an intolerance to the food.

Juliana hasn’t had a reaction to anything.  If she does have a reaction, we will have to wait for the reaction to die down before testing another food.

Dr. Mansfield offers an important lesson–that you can’t trust blood-test results.  His book goes on to recommend that if you don’t lose weight on the elimination diet, the next thing to do is to attack a systemic yeast (candida) infection, and the last thing to do is try a low-carb eating plan.  On the one hand, this is fascinating.  It’s the only place I’ve ever seen a detailed protocol for discovering whether food intolerances and yeast overgrowth, that are hinted at all over the low carb literature as possible problems, are actual problems.  But Dr. Mansfield, in my view, still doesn’t have it quite right.

For individuals who know they are carb-sensitive, have gone low-carb, and are still having trouble losing weight, try Dr. Mansfield’s diet, but a low-carb version.  Granted this doesn’t leave you much to eat, but it’s only for a few days.

 

 

Overcome obstacles with information

Every low carb eating book, article, and blog (including ours!) has a section on overcoming obstacles. Here is a sampling of some of the things that could be interfering with weight loss even when a low carb eating plan is being followed:

Food allergies or intolerances (especially dairy and wheat)
Stress or elevated cortisol levels even without stress
Poly Cystic Ovarian Disease
Yeast overgrowth
Thyroid issues
Not drinking enough water
Eating too few carbohydrates (paradoxically)
Eating too many calories overall, even if low carb calories
Medications (prescription and over-the-counter)
Inadequate nutrients to assist fat-burning (remedied by taking supplements, like l-carnitine)

In Juliana’s case, allergy medications and not drinking enough water were definite obstacles. But we’ve addressed those: she stopped taking allergy medication and instead we went to an alternative allergy practitioner who was able to clear up her mold and dust mite allergies without drugs, and she now fills and drinks several large water bottles a day, plus tea and low carb lemonade. But she is nonetheless stuck at her current weight. We tried some supplements, but didn’t notice a change. We tried eating no dairy, but didn’t notice a change. We honed in on overall calories, making sure she was eating appropriate protein and fat portions, but didn’t notice a change.

Rather than all this trial and error, wouldn’t it be great to have Information specific to your body to guide you? We just got the results of the tests Dr. Hopewell ordered for Juliana.

Lots of them were completely normal. Fasting insulin levels, cortisol levels, and thyroid function were all normal. Cholesterol was in range and most of the LDL cholesterol was the big fluffy kind. She did not show markers of Poly Cystic Ovarian Disease.

This was good and bad news. It’s good that she doesn’t have a hormonal imbalance or a thyroid problem. But it was bad because there was no smoking gun to explain her weight stall. However, there was one more set of results–the food allergy panel. Despite not having eaten gluten or wheat for 10 months, Juliana tested positive for wheat and gluten allergies. (Ordinarily food allergy reactions diminish over time when the food is not consumed). She tested positive for allergies to chicken and egg whites, and very positive for egg yolks. Since she has been eating 2 to 4 eggs every day, that could be a problem.

We are now trying an elimination eating plan where the offending foods are removed for a month. At the same time, Juliana is taking supplements to improve her gut health, since the wheat and gluten allergies may have caused leaky gut issues.